This year’s World Cancer Day motto, “Close the Care Gap,” is a theme near and dear to City of Hope. As President and CEO Robert Stone told the 40th Annual J.P. Morgan Healthcare Conference in January, “We are in a wondrous era of innovation and discovery, but there is a gap that is widening as to who can actually access these breakthroughs. We collectively need to eliminate barriers to accessing the hope created by the incredible pace of innovation so that the right care gets to the right patient at the right time and at the right location.”
Cancer Care Is Different
“City of Hope is firmly committed to democratizing cancer care and delivering innovative breakthroughs to even more patients, families and communities both close to home and across the country,” said Stone, the Helen and Morgan Chu Chief Executive Officer Distinguished Chair. One demonstration of that commitment is the organization’s foundational support of the California legislative resolution the Cancer Patients Bill of Rights, which was unanimously passed in August.
President and CEO Robert Stone
The resolution delineates certain cancer patient “rights,” such as the right to timely access to care, to information delivered in a culturally relevant manner and to access to clinical trials. “We need to advocate for the cancer patient,” Stone said. “We need to make sure that the cancer patient gets timely care. We want to make sure your outcome is determined not by your ZIP code, but by where the best treatments are for your particular type of cancer.”
Providing health care for cancer is different than for any other disease. Cancer is now recognized not as one condition, but as multiple conditions. With the emergence of genomic sequencing technology, cancer may soon be viewed as potentially hundreds of conditions.
When it comes to rare and complex cancers, patients need and deserve immediate access to providers who have the track record and expertise to treat and cure diseases.
“The consequences of limited or delayed access to state-of-the-art diagnostics are significant, leading to misdiagnoses that can often mean unnecessary exposure to toxic chemotherapy agents, suffering or avoidable death,” said Joseph Alvarnas, M.D., a hematologist-oncologist who serves as vice president of government affairs at and chief clinical advisor of AccessHopeTM at City of Hope.
AccessHope
Another way that City of Hope is helping to close the care gap is through its AccessHope subsidiary. Launched in 2019, AccessHope partners with employers (including many Fortune 500 companies) to bring the expertise of specialists from City of Hope and other National Cancer Institute (NCI)-designated comprehensive cancer centers to employees and their family members no matter their geographical location, as an employer-sponsored benefit. Today, AccessHope serves millions of plan members who have access to its cancer support services through more than 75 employers.
“We support community oncologists with getting the right treatment plan, with getting genomic information and by making sure that the diagnosis is correct,” Stone said. Current AccessHope partners include Dana Farber Cancer Institute in Boston and Emory Healthcare and Winship Cancer Institute of Emory University in Atlanta.
AccessHope also helps address cancer health disparities. A troubling gap exists between cancer treatment and cancer outcomes based on genetic, behavioral, environmental, physical, medical and social determinants of health. AccessHope brings the latest in cancer care expertise to people in underserved populations for greater health equity nationwide.
And it is working. In December 2021, the medical journal JCO Oncology Practice published a peer-reviewed study on how AccessHope influences lung cancer cases. The study found that AccessHope’s NCI-level subspecialists provided evidence-based recommendations to influence 93% of the cases AccessHope received. Accompanying the clinical and humanistic benefits was an average of $19,000 in cost savings per plan member.
Increasing Diversity in Clinical Trials
City of Hope is also committed to closing the care gap by a keen focus on increasing diversity in clinical trials.
People of different races, ethnicities, ages and sexual orientations have varying physical, genetic and environmental factors and vulnerabilities that come into play with diseases. A medication, for example, may affect patients of different races or even ages differently. If this is not researched and tested during clinical trials, crucial information may be missed.
City of Hope scientists aim to change that. “Our clinical and research scientists are conducting research studies on health disparities within diverse communities and helping us find the best ways to address complex health issues, including diversity in clinical trials,” says Angela L. Talton, senior vice president and chief diversity, equity and inclusion officer at City of Hope.
Angela L. Talton, senior vice president and chief diversity, equity and inclusion officer
City of Hope scientists are studying how diverse populations have different risk factors for and are affected differently by cancer and other diseases. The effectiveness of a treatment is often related to genetic factors — yet the patients enrolled in most clinical trials are primarily white. So City of Hope is strategically accruing people of many races to studies that advance precision medicine by exploring potential racial and ethnic differences in treatment efficacy and outcomes due to genomic variation. Kimlin Tam Ashing, Ph.D., professor in the Division of Health Equities, said she is optimistic that City of Hope is taking a significant lead in making clinical trials more inclusive.
“City of Hope has recruited scientists with a specific interest in clinical trial diversity in their own research and secured funding for health equity research, and we are better able to harness the wealth of expertise we have here,” she said. “We’re changing the paradigm of how you do clinical studies.”
Recent examples include a study led by Ashing of the common rheumatoid arthritis drug leflunomide to treat smoldering multiple myeloma in Blacks, a precursor of the blood cancer multiple myeloma, which is twice as common among Blacks. In addition, City of Hope recently received a lung cancer Specialized Programs of Research Excellence (SPORE) grant from the NCI to address the disproportionate effects of lung cancer in Black communities.
For too long, cancer studies have followed rigid eligibility requirements that overlook real-world cancer patients’ diversity, said Edward S. Kim, M.D., M.B.A., who has worked closely with ASCO and Friends of Cancer Research to reduce barriers to clinical trials.
“By ensuring trial participants look more like those we treat, we can reverse this age-old and dangerous blind spot,” said Kim, physician-in-chief, City of Hope Orange County and vice physician-in-chief of City of Hope National Medical Center. “Most importantly, our clinical findings will be more applicable to our patient populations, implemented sooner and reach more people.”
Rick Kittles, Ph.D., associate director for health equities and professor and director of the Division of Health Equities at City of Hope, is looking at the genetics of skin color and how that affects vitamin D levels, which may in turn affect cancer risk. Mustafa Raoof, M.D., M.S., surgical oncologist at City of Hope, is studying factors that make colorectal cancer deadlier for Blacks.
City of Hope is a unique institution, Stone says, able not only to “balance the creativity and freedom of an academic cancer center with the speed and rigor of industry and biotech” but nimble enough to pivot to “reinvent itself to become a national cancer research and treatment system that is focused on democratizing cancer care.”
On this World Cancer Day, that is something to celebrate.